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Physical examinations aim
- - to test hypothesis
- - confirm functional limitations
- - determine extent of physical impairments
- - sources of the symptoms
- - determine and measure physical contributing factor
- - identify and reassessment *
- - inform Rx and prognosis decisions
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What are the compontnent of examinations?
- - obs
- - functional movements
- - action movements
- - palpation- diff types
- - PPMS
- - mm tests
- - neural tests
- -PAMS
- - special tests
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What general obs?
- - posture eg spinal shift eg lumbar lordosis (weakness in hamstrings and lower abs with tightness in the quads
- - degree of weight bearing, gait
- - local signs- swelling, redness/ bruising, skin changes/ damages, mm spasm/ wasting, deformity/ asymmetry
- - irritability (how easy to stir up and settle down
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Functional movements
- - pt perorms ADL identified in the history as limite or provovative
- - care with irritable disorders to not worsen
- - eg walking (ankle), tuckin shirt in (shoulder), putting sock on (lumbar)
- - important for functional reassessment
- - repeated, quick, sustained movements as indicated- static loading you moa need to hold the position. eg standing
- - always consider the injury and how easily you can stir it up
- - you want to reproduce the pts pain
- - pt needs to inform you that it is their pain
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Active movements
- - involves mm contraction
- - moves jt structures and antagonist muscles stretched
- - some structures stretched, some compressed
- - therapist may add pressure at EROM (OP) in the movement direction to further stress structures (non- irritable cases)
- - Note pain response and ROM
- eg do you bend thru ur hip or Lsp
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What things are u palpating and looking for?
- - tenderness
- - temp
- - sweating
- - mm tone/spasm
- - test superficial structures eg lig, mm, jt line
- - helps avoid unnecessary discomfort with handling
- - helps minimise false positives with other tests
- - NOTE- do specific palpation at the end of ur obs
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Passive Physiological Movements
- - - physiological movements is a movement the pt can prodcue
- - passive- therapist does it
- - mm not activated- non contractile
- - helps differentiated mm vs inert structures as source of pain
- - end- feel, ROM- normal COMPARE to other side
- - draw movement diagram of pain response, resistance to movement
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Mm testing
- - static (isometric) tests minimise jt movement but activate/ stress mm
- -normally tested in mid- range
- - useful in differentiating between contractile and non sources of pain
- - strength/ length as appropriate
- - isometric tests- instruct pt- dont let me move you
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Static mm tests
- Interpretations of findings:
- - strong and painful: injury to musculoteninous unit
- - weak and painless: mm rupture or neurological componenet
- - weak and painful: gross lesion eg fracture
- - strong and painless: normal
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Neural tissue testing
- Two separate components:
- 1. Passive movement of neural tissue for mobility and sensitivity
- 2. spinal nerve or peripheral nerve conduction
- - learn dermatomes/ myotomes and peripheral nerve distributions
- - conductivity- mm strength, sesation, reflexes
- - test as appropriate
- - neuro dynamic test- sensivity of neuro tissue to movement
- - neurological testing is the conduction of a message
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Passive accessory movements
- - an accessory movt is a movt which the pt cant do voluntarily
- - normally occurs simultaneously with physiological movement
- - jt play
- - roll, spin, glif, distraction
- - Compare to other side
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Comparable sign
- - a physical finding which reproduces the pts symptoms ie provokes symptoms comparable to the pts complaint and relevant to their functional/ movement limitation
- - may be an active or passive movement
- - useful for treatment planning and reassessment following intervention
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Special tests
- - tests designed to evaluate the integrity of specific structures
- - apply as appropriate depending on histroy and region affected
- - eg lateral lig stress tests
- - secificity and sensitivity varies
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Reassessment
- - the repeated assessment of comparable sign to determine whether a given intervention has caused a change and the nature of that change
- - especillay informs decision- making with treatment progression, the relevance of physical impairments, and the sources of the symptoms
- - * = sign for reassessment
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